BILL SECTION 301. ADAPTING BENEFITS TO MEET THE NEEDS OF CHRONICALLY ILL MEDICARE ADVANTAGE ENROLLEES UNDER MEDICARE ADVANTAGE. Under Medicare Advantage (MA) private health plans are paid a per-person monthly amount to provide all Medicare-covered benefits (except hospice) to beneficiaries who enroll. Unlike original Medicare, where providers are paid for each item or service provided to a beneficiary, an MA plan receives the same capitated monthly payment regardless of how many or few services a beneficiary actually uses. The plan is at-risk if aggregate costs for its enrollees exceed program payments and beneficiary cost sharing; conversely, in general, the plan can retain savings if aggregate enrollee costs are less than program payments and cost sharing. Currently, an MA plan must offer the same benefit package to all of its enrollees. This section would expand the testing of the CMMI Value-Based Insurance Design (VBID) Model to allow an MA plan in any state to participate in the model by 2020 (during the testing phase) to determine whether savings are achieved without negatively impacting quality.

We are pleased to recognize the further expansion of the CMS MA V-BID demonstration to all states by January 1, 2020, and the inclusion of funding to design, implement, and evaluate the model test. This growing bipartisan support and expanded role of V-BID principles in public and private payers builds on the TRICARE V-BID demonstration included in the National Defense Authorization Act for fiscal year 2017, and H.R. 5652 “Access to Better Care Act of 2016.” This bipartisan bill provides high-deductible health plans the flexibility to provide coverage for services that manage chronic disease prior to meeting the plan deductible.

A. Mark Fendrick, MD, developer of the V-BID concept and Director of the University of Michigan V-BID Center, is available for questions or comments.

View the resources below to learn more about V-BID in Medicare Advantage.